Abstract
Substance abuse has long been conceptualized through various biological, behavioral, and social frameworks. However, a trauma-informed psychodynamic perspective offers a more comprehensive understanding of why individuals become dependent on psychoactive substances. In this view, addiction is not merely a pattern of compulsive behavior or a chemical dependency, but rather a maladaptive attempt to regulate internal states shaped by unprocessed trauma. Specifically, I adopt and elaborate a trauma model of substance abuse grounded in the self-medication hypothesis, inspired by insights from attachment theory and dissociation research.

From this perspective, attachment trauma—including failures of care and abuses—can compromise a person’s ability to represent and regulate emotional experiences. These early wounds often remain unintegrated, and become encapsulated instead in dissociated mental states that continue to exert unconscious influence. When these dissociative barriers are threatened, overwhelming affective states may surface, often experienced as inexplicable anxiety, emptiness, or rage. In this way, substance use becomes an external regulator of affect—a way to self-soothe and suppress these disjointed self-states.

However, this strategy comes at a cost. Rather than integrating these painful emotional states, substances reinforce their segregation, creating a false sense of control and emotional mastery. Over time, individuals develop rigid compartmentalization of self-states: in many cases, vulnerable, shame-laden parts are pushed out of awareness, while grandiose or omnipotent self-states emerge under the influence of drugs or alcohol. This dissociative shift, while having a temporarily stabilizing effect, further impairs the individual's ability for self-integrity and self-cohesion.

The trauma model thus positions substance abuse as a repetitive, unconscious re-enactment of early traumatic dynamics. The substance becomes not only a chemical retreat but also a symbolic reenactment of unmet relational needs, especially in those with histories of traumatic attachment. These individuals may develop addictive patterns not to seek pleasure per se, but to avoid the psychological pain linked to traumatic self-discontinuity, emotional isolation, and unmet developmental needs.
This understanding has relevant clinical implications. Interventions should not aim solely at abstinence or behavioral change but must address the underlying traumatic structure that fuels the addiction. Psychodynamic therapy, with a strong focus on dissociation, affect regulation, and the integration of trauma-related self-states, becomes essential. Helping individuals recognize their substance abuse as a maladaptive form of self-medication for deeper psychological wounds enables them to reestablish a more integrated self. In summary, the trauma model of substance abuse reframes addiction as a desperate effort to manage unbearable internal states resulting from unprocessed attachment trauma. This paradigm invites clinicians to see addiction as a symptom of a dissociated self—and thus to treat the person, not merely the behavior.

Potential to Distress: Yes

This presentation was originally presented as a live webinar in July 2025